Contemporary role of nevirapine in HIV treatment.

Nevirapine was the first nonnucleoside reverse transcriptase inhibitor that was approved for treatment of HIV infection and quickly became an important component of HAART. As experience with this drug grew, potential toxicities and significant clinical benefits became apparent. With the development of new patient criteria based on CD4(+) cell counts, new treatment initiation guidelines were developed. Incorporation of these criteria has reduced the incidence of rare but significant toxicities associated with nevirapine therapy to levels seen with other drugs. For treatment-naive patients who meet established starting criteria, or for patients switching from other nonnucleoside reverse transcriptase inhibitor- or protease inhibitor-based regimens, nevirapine can offer potent and durable viral suppression with significant clinical benefits. These benefits include the absence of central nervous system effects in patients who are at risk for depression, minimal untoward effects on serum lipid profiles, which is especially important for patients who have other cardiovascular disease risk factors, and relative safety during pregnancy for women of childbearing age. Patients who should avoid nevirapine include those with prior hypersensitivity reactions, those who do not meet treatment initiation criteria, those who experience adverse reactions during induction, and those with existing hepatotoxicity. This review focuses on current information regarding the role of nevirapine in HAART and defines patient groups whose clinical profiles may warrant consideration of nevirapine.